Individual
KENNETH COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
739 IRVING AVE, SUITE 450, SYRACUSE, NY 13210-1651
(315) 470-7364
(315) 470-5859
Mailing address
1001 W FAYETTE ST STE 400, SYRACUSE, NY 13204-2866
(315) 937-3433
(315) 470-5859
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
244186
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02901417
—
NY
Enumeration date
07/13/2007
Last updated
04/09/2021
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